Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

What is codeine, and how does it work (mechanism of action)?

Codeine is a narcoticpain-reliever and cough
suppressant similar to morphine and hydrocodone. Moreover, a small amount of
codeine is converted to morphine in the body. The precise mechanism of action of
codeine is not known; however, like morphine, codeine binds to receptors in the
brain (opioid receptors) that are important for transmitting the sensation of
pain throughout the body and brain. Codeine increases tolerance to pain,
decreasing discomfort, but the pain still is apparent to the patient. In
addition to reducing pain, codeine also causes sedation drowsiness and depresses
breathing. Codeine frequently is combined with
acetaminophen (Tylenol) or
aspirin
for more effective pain relief. The FDA approved codeine in 1950.

Is codeine addictive? Is it a controlled substance?

Codeine is habit forming (addictive). Mental and physical dependence can occur but are unlikely when used for short-term pain relief. Using codeine during pregnancy can cause opioid withdrawal syndrome in the newborn, which may be life-threatening if not treated.

Yes, you need a prescription for codeine. Codeine is a schedule II controlled substance in the US.

What is the dosage?

The usual adult dose of codeine for pain is 15-60 mg every 4-6 hours as needed. The dose for cough is 10 to 20 mg every 4-6 hours as needed. The maximum dose for treating cough is 120 mg every 24 hours.

Can I drink alcohol with codeine? What other drugs cause interactions with codeine?

Codeine can impair thinking and physical abilities required for driving or operating machinery.

Alcohol and other sedatives such as alprazolam (Xanax) can produce further brain impairment and even confusion when combined with codeine. Therefore, alcohol and other sedatives should not be used when taking codeine.

Drugs that stimulate and also block opioid receptors (for example, pentazocine) reduce the effect of codeine. Such drugs should not be combined with codeine.

Drugs that block the action of acetylcholine (anticholinergic drugs) increase the occurrence of urinary retention and constipation when combined with codeine.

More serious adverse effects are severe low blood pressure, adrenal insufficiency, accidental ingestion of codeine, which can result in fatal overdose. Since codeine is a narcotic it has a potential
for abuse. Patients with current or previous drug addiction problems should be
monitored closely for addiction. Dependence and addiction can occur with
codeine, even at prescribed dosages when taken over long periods. Misuse of
codeine can lead to serious cardiac events and sudden death.